Palliative Care Needs Rounds assist residents facing the end of their life: opinion

Deaths in residential aged care settings occur frequently enough to be core business. It is sometimes difficult to assess when an individual might be dying, and sometimes an acute event means that they may be transferred to hospital and die there. If possible, it would be helpful for both the resident and their family members if they could die where they have lived.

Supporting a resident in their final days in their home, a place that is familiar, has many benefits. Among them is that the individual and their particular ways of doing things is known to the staff; and the resident is more likely to know the staff.

Studies show that a busy and noisy emergency department can cause confusion and distress for older people, adding to what may already be a complex medical picture.

Palliative Care Needs Rounds (Needs Rounds) have been established in many community-based palliative care services across Australia to support aged care staff in their care of residents facing the end of their life, and to reduce the numbers of transfers to other care settings.

They consist of a monthly 60 minute meeting, where aged care staff choose a few residents they are concerned about, for review with visiting palliative nurse care clinicians.

This enables a focus on those who are at greater risk of dying without a plan in place and who have difficult symptoms. This service recognises that an aged care setting is most often the resident’s final home and aims to assist them to die there if that is their wish. 

Staff prioritise those who meet the following criteria:

• it would not be a surprise if the resident died in the next six months
• there has been physical and/or cognitive decline or increase of symptoms in the last month
• there are no plans in place for last six months of life/no advance care plan
• there is conflict within the family about treatment and care options, and
• the resident was transferred to the aged care home for end of life care.

The Needs Rounds are led by specialist palliative care staff from the local palliative care service and include any aged care staff wishing to attend.

The discussion, based around an individual’s bio-psycho-social needs, provides a practical opportunity to extend aged care staff members' clinical understanding and knowledge.

Discussion of residents at the Needs Rounds frequently leads to further supportive activities like initiating a case conference; conducting advance care planning with resident input, where appropriate; management of current and anticipatory medicines; and/or identifying legally appointed alternate decision-makers.

Research studies show that where Needs Rounds are implemented in an aged care setting, residents spend less time in hospital and have less hospital admissions. They are more likely to die in their preferred place and have better controlled symptoms, meaning they have a better death.

For aged care staff, participating in the Needs Rounds has enabled them to feel more confident in their care and in recognising dying as a normal part of life.

Dr Margaret O’Connor is Emeritus Professor of Nursing at Monash University and Clinical Researcher at Melbourne City Mission Palliative Care.

Suzie Grogan is a Registered Nurse, Clinical Nurse Consultant for Aged Care, at Melbourne City Mission Palliative Care.

Do you have an idea for a story?
Email [email protected]